One of the things I was woefully unprepared for when it came for advocating for my two special needs kids was the labyrinthine tunnels of insurance and finance I would need to traverse. I never aspired to be an expert in medical coding, balance billing and all the rest.
But it’s part of the job.
The Special Needs Mom Job, that is.
Our first shocker following 4 of 8’s diagnosis with hearing loss was discovering that most insurance companies are able to duck paying for hearing aids for hearing impaired children. They have classified hearing aids as a durable medical good not covered within the context of most policies. While several state have adopted laws requiring insurance companies to pay for hearing aids, they can only enforce such laws on insurance companies based in their states. A pesky little item called Erisa Law allows insurance companies to not be subject to state laws, only federal. While Erisa Law was not intended for this purpose, but to protect retirement rights, a loophole has left an open door in its interpretation. Federal law does not yet mandate hearing aid coverage.
We’ve weathered other surprises as we continue to search for the optimal care and therapy for our girls. We have been delighted with some of our insurance coverage, dismayed at other times, appreciative of medical business offices that have been easy to work with and frustrated at others which have made things more difficult. Hopefully, I’ve picked up a few tips along the way for dealing with pot holes and hic-ups on the way…
1. Don’t take ‘No’ as your first answer.
Granted, there are things that are simply concretely written into your insurance policy, but there are some areas that have a bit of gray to them. It’s always worth calling a second time and a third until someone can send you, in writing, the explanation specific to the denial of your claim.
2. Be sure to ask about double billing.
Double billing is when, through the twists and turns of insurance filling, a medical provider’s records have not yet posted that payment has been received and they bill you for the remainder on your invoice. I’ve been surprised at the number of times this has been an issue. Always clarify with your insurance company what they have paid and what is pending.
3. Learn to read and understand your EOBs (Explanation of Benefits).
Our particular insurance company sends us regular statements outlining what they have paid and in what amounts. While these statements were originally very confusing to me, I called my insurance provider and had someone walk me completely through the way they do their bookkeeping and reporting. This has been invaluable as I continue to review and monitor the girls’ records.
4. Don’t be afraid to ask your medical provider’s business office to review the way they are ‘coding’ the services you are receiving.
You would be amazed at the difference a few pesky little numbers and letters make when it comes to the medical codes sent in as part of the billing information by medical offices. If the code for 4 of 8’s continuing speech/auditory verbal therapy is sent in one way, the insurance company spits it back to us and will not pay. However, the simple use of a different code that provides the same therapy makes all the difference.
5. When you do have money owed to medical providers, think out of the box to pay those balances down.
Some providers will give you some time to make payments, and others can point you in the right direction for finding financing for those balances. You might also consider using balance transfer credit cards with low or no-interest to structure payments on your timetable within what is comfortable for your budget.
6. Learn to bargain shop.
Okay, that might sound a bit risky and jaded. But I found out something astounding when we began having to purchase hearing aids (in the range of thousands of dollars) every few years for 4 of 8. There are many hearing aid providers out there whose primary business is the business of selling hearing aids. Therefore, they place a significant mark-up on hearing aid devices. We made the mistake the first time around and paid far more than we should have for an inferior product. We now always purchase 4 of 8’s hearing aids through Hearts for Hearing, a non-profit organization whose primary mission is to teach hearing impaired children to listen and talk. They actively fund raise throughout the community so that parents can purchase equipment for their children at cost. In 7 of 8’s case, her physical therapist is working hard to have a special bicycle donated to 7 of 8 that would facilitate the use of her legs and arms in tandem. It takes some looking to find these kinds of organizations, but they are well worth the hunt.
7. And finally, don’t be afraid to keep going up the chain.
Customer service specialists and capable managers of medical business offices are worth their weight in gold. I have so appreciated the individuals who have taken the time to search for an answer, submit another request, walk me through mounds of paperwork. If the person you are speaking with doesn’t seem to have an answer, or is giving you an answer that is unacceptable, politely ask to speak to someone a notch up. My willingness to continue calling back and being referred up has resulted in saving many hundreds of dollars on various issues.
If you’re faced with some of these oh-so-fun billing and insurance issues, hang in there. Hopefully the application of a few of the tips will ease the sting and in no time you too will navigate such stormy waters with success!